Or maybe worse: While Romney signed a state mandate into law, Gingrich once went a step further and advocated a federal one.

Gingrich backed a federal mandate in the early 1990s as an alternative to the health care proposal Hillary Clinton pushed. Today, he describes himself as “completely opposed” to the federal mandate in the health reform law President Barack Obama signed last year.

But Gingrich’s early support for a mandate — now anathema to Republican politicians — isn’t the only time he’s backed health reform ideas popular with Democrats.

In 2000, he praised Don Berwick, whose recess appointment to head the Centers for Medicare & Medicaid Services is expiring amid opposition from Senate Republicans.

As founder of the Center for Health Transformation, Gingrich also has supported using electronic health records in evidence-based medicine, a concept that some backers of the health law liken to “comparative effectiveness research.”

And he once wrote an op-ed praising a Wisconsin health system’s approach to end-of-life care — which later got embroiled in the charges that the Democrats’ health reform law would include “death panels.”

The “death panels” were the bête noire for Republicans as health reform made its way through Congress. But now it is the individual mandate — due to go before the Supreme Court this spring — that has become a litmus test for Republicans in the presidential race.

Some in the GOP believe Romney’s support for a mandate in Massachusetts would limit his ability to score points against Obama’s health care law in a general election matchup next year.

Gingrich himself took a thinly veiled swipe at Romney on the issue Monday — depicting Romney as a flip-flopper but himself as someone whose views have evolved out of principled growth.

“I wouldn’t lie to the American people; I wouldn’t switch my positions for political reason,” Gingrich told WSC, a South Carolina radio station. “It’s perfectly reasonable to change your position … if you see new things you didn’t see. Everybody’s done that; Ronald Reagan did it. It’s wrong to go around and adopt radically different positions based on your need of any one election, because then people have to ask themselves, ‘What will you tell me next time?’”

But that doesn’t make the mandate issue go away for Gingrich — not after he supported it for years.

“I think that Newt Gingrich’s support of the mandate, like Romney’s, is emblematic that Republicans don’t pay much attention to health care,” said Michael Cannon, director of health policy studies at the Cato Institute. “They’ll fall for something that really does contradict conservative principles.”

Gingrich supported the idea of requiring Americans to buy insurance at least as early as the 1990s, as the Clinton White House tried to pass a health reform bill.

Romney reminded Gingrich of that during an October debate in Las Vegas.

“Newt, we got the idea of the individual mandate from you,” Romney told him pointedly during the CNN debate, trying to deflect criticism that the Massachusetts plan had paved the way for the 2010 federal mandate.

“You did not get that from me. You got that from The Heritage Foundation,” Gingrich responded, later adding that he “absolutely” supported the idea of a mandate “with The Heritage Foundation against ‘Hillarycare.’” At that time, the individual mandate was primarily a Republican concept, offered as an alternative to the Clinton plan.

Gingrich has long supported the idea of “personal responsibility” and has criticized people who shun insurance even if they can afford it as “free-riders” who assume their neighbors will pay for their care if they get sick or injured.

Although the “personal responsibility” argument has gotten a sliver of Republican support, the individual mandate has emerged as the centerpiece of opposition to the federal health law.